The nurse discusses these options with Jennifer. Jennifer would like to try to use goal setting and an anxiety diary. Together they develop a personalised goal setting plan. They try to focus on what Jennifer’s most important aims are and make the goals achievable. The nurse also explains to Jennifer how she may use her diary to chart when she has these feelings of anxiousness and what she is doing or planning on doing at the time they occur. The nurse also instructs Jennifer in effective diaphragmatic breathing techniques which some people find useful in helping them to relax. For further information on breathing techniques see the ‘Additional Information’ box below.
Jennifer Parks 10th June: goal setting
Aim
Goal
Date to be achieved
Recognise triggers of anxiety
Recognise triggers/effective use of diary/use rating scales 1-10 (10 indicating extreme anxiety)
24th June (2 weeks)
Use diaphragmatic breathing technique at home when feelings of anxiety present.
24th June (2 weeks)
Use diaphragmatic breathing technique outside the home if anxiety presents.
2nd July (3 weeks)
Walking to church
Gain confidence walking outside accompanied for 10 minutes.
24th June (2 weeks)
Walk to church accompanied, 20 minute walk.
2nd July (3 weeks)
Walk to church independently.
10th July (one month)
Walk Tipsy her dog
Walk Tipsy accompanied to the bus stop, 10 minute walk.
24th June (2 weeks)
Walk Tipsy accompanied to the paper shop, 15 minute walk.
2nd July (3 weeks)
Walk Tipsy unaccompanied to the paper shop.
10th July (one month)
This goal setting plan will be reviewed on a regular basis.
Additional Information
Breathing for relaxation
One of the key symptoms of anxiety or stress is fast or shallow breathing. This needs to be controlled.
A simple relaxation technique focuses on a form of deep breathing that is very useful for preventing the stress response from building up.
It is called Diaphragmatic Breathing.
This technique makes full use of the diaphragm – a sheaf of muscle between your lungs and your stomach.
To Take a Deep Diaphragmatic Breath
Imagine your lungs divided into three parts.
Breathe in gently through your nose.
Visualise the lowest part of your lungs filling with air. If you are using your diaphragm, your stomach will come out a bit, as your lungs fill with air.
Imagine the middle part of your lungs filling.
Imagine the upper part filling with air and your lungs becoming completely full.
Hold the breath for a second or two. The whole of the top part of your body should feel tense.
Gently breathe out fully and completely and relax.
A Pattern for Diaphragmatic Breathing
Organise a reminder for yourself to practice the habit of taking diaphragmatic breaths during the day. One or two breaths every half-hour, every day, is ideal. That is, 20 or 30 breaths scattered throughout the day.
Use diaphragmatic breathing to prevent the build up of the stress response on a regular basis, even if you feel quite relaxed.
If you feel stressed, the breathing can help you to calm down.
Link diaphragmatic breathing with your normal routine so it becomes easy to remember to do it.
For example, every time you make yourself a drink or go to a certain part of the house, stop and do one or two breaths.
Put up a notice where you will keep seeing it. Every time you see the notice take a couple of deep breaths.
Remember that you don’t have to stop what you are doing to breathe diaphragmatically.
